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          <h1 class="post-title" itemprop="name headline">口外常用器械(除拔牙器械以外)</h1>
        

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        <p>还是读书的总结。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0008-kwcyqxcbyw/01.jpg"><br>外科单元（外科手术刀？Surgical Unit）和外科手机（Handpiece）。<br>去骨钻(Bone Burs):是球钻或者裂钻。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0008-kwcyqxcbyw/02.jpg"><br>手术刀（刀柄Handle和刀片Blade）：<br>刀柄：口外最常用的是 Bard-Parker3号刀柄。(<a target="_blank" rel="noopener" href="https://zhuanlan.zhihu.com/p/26256568">https://zhuanlan.zhihu.com/p/26256568</a>)<br>刀片：一次性使用，有三种不同的类型（11,12,15号，11号stab knife，穿刺刀，尖刀片，适合穿刺，打孔；12号月牙刀，有尖细如月牙般的刀头，可以用来挑断线结。15号，最常见的刀片，一般用于比较短和精细的切口。）<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0008-kwcyqxcbyw/03.jpg"><br>最常用的是15号刀片，用来切开缺牙区牙槽嵴。12号刀片用来切开龈沟和牙齿后部，特别是上颌结节(maxillary tuberosity)区。11号刀片用来切小的切口，如切开排脓。<br>使用持针器将刀片上到刀柄上。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0008-kwcyqxcbyw/04.jpg"><br>握手术刀的方法是握笔式的。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0008-kwcyqxcbyw/05.jpg"><br>骨膜剥离器（Periosteal Elevator）</p>
<p>在口内手术中最常用的是9号Molt，有两个不同的末端：比较尖的末端，用来剥离牙齿之间的龈乳头，一个宽的末端，用来从骨头上剥离粘骨膜。自由剥离器（Freer elevator）用来在拔牙前折起（reflecting）周围的牙龈。（牙龈分离器吗？不像啊。）剥离器也可以用来在翻瓣以后持住瓣，方便手术操作。Seldin剥离器最适合进行这项任务。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0008-kwcyqxcbyw/06.jpg"><br>止血钳(Hemostats):有直的和弯的，在口外中都有应用。</p>
<p>最常用的是弯的蚊式钳(curved mosquito type）或者micro-Halsted止血钳。因为它们有比较小的和窄的喙缘，可以夹住血管以止血。止血钳也可以用来夹持住软组织，便于操作。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0008-kwcyqxcbyw/07.jpg"></p>
<p>外科组织镊：用于缝合创面边缘，在缝合针穿过的时候，牢固的夹住组织。有两种类型，长的标准的，用于后牙区，以及小的弯的Adson组织镊，用于前牙区域。<br>镊的尖端有一侧有楔形的或齿状的突起。另一边有相应的凹陷，可以相互锁紧。这可以使组织镊能够牢固的夹紧组织。而解剖镊(Anatomic foceps)没有这种突起和凹陷。这种组织镊用来辅助缝合创缘，夹小的器械等。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0008-kwcyqxcbyw/08.jpg"></p>
<p>咬骨钳（Rongeur Forceps）：在术中或术后用来去骨，修整骨刺等。它们的尖端变得很锐，当捏柄的时候，它们能把在它们之间的骨骼给切断，而不用施加太大的压力。最常用的是Luer–Friedmann，因为其刃口是可以同时切除末端和侧面骨头的。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0008-kwcyqxcbyw/09.jpg"><br>骨挫(Bone File)<br>有两个末端：一个较小而另一个有较大的表面。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0008-kwcyqxcbyw/10.jpg"><br>工作端有很多平行的刃，被设计成只有牵拉才能有效工作。在口外手术中用于平滑骨面，但并不移除大的骨片。<br>骨凿和锤子（Chisel and Mallet）：现在临床基本不用了（也许其它手术还用？），就不看了。都用手机或者超声骨刀之类的东西了。<br>持针器（Needle Holders)：用来缝合。常用Mayo–Hegar和Mathieu持针器。(后者我没见过，只用前者）<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0008-kwcyqxcbyw/11.jpg"><br>前者很像止血钳，在口内缝合用的较多。<br>止血钳和持针器的区别（这个我经常混淆）：①短喙的止血钳要比持针器更薄并且更长。②对于持针器，短喙的内面（夹针那一面）是带有交叉纹路（grooved and crosshatched）的，使缝针能被夹的更稳。而止血钳的尖端内面是平行的纹路，与器械长轴垂直。③持针器可以用很小的压力就释放缝针，因为在末端有齿可以锁住持针器，而止血钳需要一个特别的步骤（special maneuver），因为其末端没有这样的齿。(我看了一下，貌似止血钳末端也是有齿的。所以主要还是看第二条，看纹路的形态，是交叉的还是平行的。）<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0008-kwcyqxcbyw/12.jpg"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0008-kwcyqxcbyw/13.jpg"></p>
<p>持针器正确的持握方法是，拇指和无名指放在后部环里，其它两个指头环绕在环外，示指伸向前到关节的地方。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0008-kwcyqxcbyw/14.jpg"><br>剪刀(Scissors)：分为缝合剪，用来剪缝线。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0008-kwcyqxcbyw/15.jpg"><br>组织剪：用来去除多余牙龈组织。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0008-kwcyqxcbyw/16.jpg"><br>持握方式与持针器一致。<br>巾钳（Towel Clamps）：用来夹无菌洞巾的。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0008-kwcyqxcbyw/17.jpg"><br>牵引器(Retractors）：基本用不到，不说了。<br>咬合垫和开口器（Bite Blocks and Mouth Props）：略了。<br>外科吸引器（Surgical Suction）:有多种设计的用来吸去血液，唾液和其它分泌物。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0008-kwcyqxcbyw/18.jpg"><br>冲洗器械（irrigation instruments)：略。<br>电刀：提供高频电磁波用来进行血管和切口止血的设备。用电来帮助切除组织叫电外科(electrosurgery)。主要组成部分为：①正电极（active electorde），常用手柄连接，用来接各种电外科工作尖以切割或止血。②负电极(passive electorde），或叫接地极，是一块金属板，直接与患者裸体皮肤相接触，为了安全这是必要的。③脚踏板，用来控制是否接通电刀。④开关，主要有烧蚀开关，电压开关，切割开关，还有烧蚀和切割的混合开关。<br>自带光源头戴式放大镜(Binocular Loupes with Light Source)<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0008-kwcyqxcbyw/19.jpg"><br>接下来就是我们牙医最关心的拔牙器械啦。下次吧。</p>
<p>我发文章的三个地方，欢迎大家在朋友圈等地方分享，欢迎点“在看”。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的知乎文章地址： <a target="_blank" rel="noopener" href="https://www.zhihu.com/people/zhao-you-min/posts">https://www.zhihu.com/people/zhao-you-min/posts</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/other/wx.jpg"></p>

      
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